Filling Voice Promotion Gaps in Healthcare through a Comparative Analysis of Error Reporting and Learning Systems and Open Communication and Disclosure Policies in the United States and Germany.

Voice in healthcare is crucial because of its ability to improve organizational performance and prevent medical errors. This paper contends that a comparative analysis of voice promotion in the American and German healthcare industries can strengthen a culture of safety in both countries. It provides a brief introduction to the concept of voice in healthcare, including its impact on safety culture, barriers to voice, and the dual influences of confidentiality and transparency on voice promotion policies. It then examines the theoretical basis, practical workings, and legal aspects of voluntary error reporting and error disclosure as avenues for exercising voice in the U.S. and Germany. Finally, it identifies transferable practices that can remedy shortcomings in each country's voice promotion policy.

Internal Controlling of a Radiology Department.

Caused by legal reform initiatives there is a continuous need to increase effectiveness and efficiency in hospitals and surgeries, and thus to improve processes.Consequently the successful management of radiological departments and surgeries requires suitable structures and optimization processes to make optimization in the fields of medical quality, service quality and efficiency possible.In future in the DRG System it is necessary that the organisation of processes must focus on the whole clinical treatment of the patients (Clinical Pathways). Therefore the functions of controlling must be more established and adjusted. On the basis of select Controlling instruments like budgeting, performance indicators, process optimization, staff controlling and benchmarking the target-based and efficient control of radiological surgeries and departments is shown.

[Efficiency of inspections of the corpse before cremation performed in the area of the Halle University Medical Centre]. / Effizienz der Krematoriumsleichenschau im Bereich des Universitätsklinikums Halle.

From 1993 to 2007, the Institute of Forensic Medicine in Halle conducted 882 post-mortems before cremation. These records were now used for a systematic analysis of these cases to assess the efficiency of so-called second inspections of the corpse carried out in the area covered by the Halle University Hospital. In the period under review, considerable fluctuations were found from year to year, but these are mainly attributable to changes in the Saxony-Anhalt burial law introduced in 2002. Our 882 post-mortems were based on 84,677 corpse inspections before cremation; thus, an autopsy was performed in about 1% of all cases. Males were significantly overrepresented, younger age groups were dominant and there was a relatively high percentage where the first inspection of the corpse could not determine the manner of death or had to declare death by an unnatural cause. With regard to the manner and cause of death, the results of the first inspection and the post-mortem differed significantly. In 17.6% of our 882 cases, only the post-mortem revealed that death had been due to an unnatural cause. Despite the presence of sometimes strong clues to an unnatural cause, 156 of these cases were classified as natural deaths (56.4%) or the manner of death was stated as undetermined (43.6%). For more than two thirds of these 156 cases we were able to inspect the records kept by the Departments of Public Prosecution. 105 of these at first overlooked cases of unnatural deaths turned out to be deaths by accident. The other cases included 11 suicides, and 36 deaths related to medical treatment. In the remaining four cases, the autopsy results strongly suggested homicide, but only in one of these four cases subsequent police investigations were able to identify the perpetrator. This outcome demonstrates that the rule of inspecting the corpse a second time before cremation is clearly indispensable, even in its currently rather limited form.

A critical appraisal of physician-hospital integration models.

The economic environment and the current health care debate have prompted a critical reevaluation of previous and current physician-hospital integration models. Even though the independent, self-employed, private practice, medical staff remains the most common model, surgical specialists such as vascular surgeons are increasingly being employed and integrated into health care delivery systems. The degree of integration varies from minimal to full integration or full employment. This review defines the forces driving these changes and analyzes the strengths and weaknesses of each employment model from the physicians' point of view. Strategies for the successful implementation of a 21st century integrative employment model are discussed.

[Legal implications of the limitations of competition in healthcare systems]. / Juristische Implikationen der Grenzen des Wettbewerbs im Gesundheitswesen.

Limitations of competition in our healthcare system follow from both the natural results of competition and the natural requirements for working competition. The legal implications of the limitations of competition in our healthcare system are twofold: they comprise the right and the duty of the government and the legislator to ensure fair and functional regulation.

Distinctiveness of management in a university psychiatric hospital as a public health institution.

The distinctiveness of management of a university psychiatric hospital which has the status of a public health institution is manifested in the following ways: * Distinctive features and characteristics of managing service provider organizations compared to those whose operational results involve tangible products; * Distinctive features of management which originate from its role as a regional hospital and a tertiary research and educational institution in the field of psychiatry, with special importance for the Republic of Slovenia as a whole; * Distinctive features of management that are defined by the social and legal framework of operation of public health institutions and their special social mission. This paper therefore discusses the specific theoretical and practical findings regarding management of service provider organizations from the viewpoint of their social mission and significance, as well as their legal organization, internal structure and values.

Los niveles de la justicia sanitaria y la distribución de los recursos / The levels of health justice and the distribution of resources

El derecho a la asistencia sanitaria es una conquista social de los Estados democráticos de derecho. Para que esto se haga efectivo de una manera justa se requiere el concurso de muchos elementos que se analizan en este artículo en sus diversos momentos: el Estado como garante de este derecho y limitador de las prestaciones; las instituciones sanitarias, gestoras directas de la asistencia, que deben combinar la eficiencia y la equidad; y por último los profesionales de la salud verdaderos distribuidores finales de los recursos. La medicina tradicional siempre dejó fuera de su ámbito la evaluación de los factores socioeconómicos. Incluso llegó a considerar que estas cuestiones eran opuestas al buen ejercicio de la medicina. En la actualidad tal afirmación es insostenible. Para un profesional sanitario el camino hacia la eficiencia pasa por asegurar la efectividad clínica, garantizando de esta manera tanto el bien del paciente como la adecuada distribución de los recursos

The right to health care is a social achievement of democratic states based on law. In order for this to become effective in a just way, it is necessary for many elements to come together. This article analyses these elements in their different moments: the state as a guarantor of this right and to limit assistance; the health institutions, direct managers of care, which must combine efficiency and equity; and, finally, the health professionals, who are in the final instance the real distributors of resources. Traditionally medicine always omitted evaluation of the socio-economic factors from its sphere. It even came to consider that these questions were opposed to good medical practice. Today such an assertion is unsustainable. For a health professional the path to efficiency passes by way of assuring clinical effectiveness, in this way guaranteeing both the patient’s interest and the suitable distribution of resources